Department of Cardiology, Wuhan Fourth Hospital, Wuhan, Hubei, China.
Department of Ultrasonic Imaging, Wuhan Fourth Hospital, Wuhan, Hubei, China.
Can Respir J. 2023 May 10;2023:8246730. doi: 10.1155/2023/8246730. eCollection 2023.
To explore the prognostic risk factors of 30-day death in patients with traumatic lower limb fracture (TLLF) complicated with acute pulmonary embolism (APE).
295 consecutive TLLF patients diagnosed as APE according to pulmonary artery CT angiography, hospitalized in our hospital from January 2017 to December 2021, were included in this study. Patients were divided into nonsurvival group and survival group according to 30-day follow-up results. After adjusting age, sex, and all the clinical variables with values of <0.2 with backward stepwise method (likelihood ratio), multivariate Cox regression analysis was used to analyze risk factors of 30 days all-cause death in TLLF patients with APE. The area under curve (AUC) calculated by receiver operating characteristic curve (ROC) and the incremental model were used to determine the prognostic potential of identified risk factors.
29 patients died during 30-day follow-up. Simplified pulmonary embolism severity index (sPESI) score ≥1 ( < 0.05), Wells score ≥7 ( < 0.01), and pulmonary hypertension ( < 0.01) were associated with higher risk, while anticoagulant therapy ( < 0.01) was associated with lower risk of all-cause death during 30 days follow-up in APE patients. Compared with sPESI score, Wells score plus pulmonary hypertension produced better predictive efficacy. Prognostic value of sPESI score could be enhanced by adding Wells score, pulmonary hypertension, and anticoagulant therapy to the predicting models.
Wells score ≥7 and pulmonary hypertension are independent predictive risk factors of 30-day all-cause death in TLLF patients with APE.
探讨创伤性下肢骨折（TLLF）合并急性肺栓塞（APE）患者 30 天死亡的预后危险因素。
本研究纳入了 2017 年 1 月至 2021 年 12 月期间因肺动脉 CT 血管造影术诊断为 APE 而住院的 295 例连续 TLLF 患者。根据 30 天随访结果，患者被分为存活组和死亡组。通过向后逐步法（似然比）调整年龄、性别和所有 P 值<0.2 的临床变量后，采用多变量 Cox 回归分析分析 TLLF 合并 APE 患者 30 天全因死亡的危险因素。通过接收者操作特征曲线（ROC）计算曲线下面积（AUC）和增量模型，确定识别的危险因素的预后潜力。
29 例患者在 30 天随访期间死亡。简化肺栓塞严重指数（sPESI）评分≥1（ P<0.05）、Wells 评分≥7（ P<0.01）和肺动脉高压（ P<0.01）与更高的死亡风险相关，而抗凝治疗（ P<0.01）与 APE 患者 30 天内全因死亡的风险较低相关。与 sPESI 评分相比，Wells 评分加肺动脉高压产生了更好的预测效果。将 Wells 评分、肺动脉高压和抗凝治疗添加到预测模型中，可以增强 sPESI 评分的预测价值。
Wells 评分≥7 和肺动脉高压是 TLLF 合并 APE 患者 30 天全因死亡的独立预测危险因素。
